Intervention Summary

STARS for Families

Start Taking Alcohol Risks Seriously (STARS) for Families is a health promotion program that aims to prevent or reduce alcohol use among middle school youth ages 11 to 14 years. The program is founded on the Multi-Component Motivational Stages (McMOS) prevention model, which is based on the stages of behavioral change found within the Transtheoretical Model of Change. The McMOS model posits a continuum of five stages in the initiation of alcohol use: precontemplation (has not tried alcohol in the past year), contemplation (is thinking about trying alcohol soon), preparation (is planning to start drinking soon), action (started drinking in the past 6 months), and maintenance (has been drinking for longer than 6 months). STARS for Families intervention materials are tailored to the individual's stage of alcohol use initiation.

STARS for Families has three components. Youth who participate in the program receive brief individual consultations in school or in after-school programs about why and how to avoid alcohol use, and they may also receive a follow-up consultation. These standardized sessions are provided by trained adults guided by protocols. A series of eight postcards are mailed to parents/guardians providing key facts about how to talk to their children about avoiding alcohol. In addition, the family completes four take-home lessons designed to enhance parent-child communication regarding prevention skills and knowledge. These three components can be implemented separately or in various combinations. In addition to its implementation in school and after-school settings, the program also has been used in health clinics, youth organizations, and homes.

Descriptive Information

Areas of Interest

Substance abuse prevention

Outcomes

Review Date: March 20081: Heavy alcohol use2: Quantity of alcohol use3: Frequency of alcohol use4: Stage of alcohol use initiation5: Intentions to use alcohol in the future

Outcome Categories

Alcohol

Ages

13-17 (Adolescent)

Genders

MaleFemale

Races/Ethnicities

Black or African AmericanWhiteRace/ethnicity unspecified

Settings

School

Geographic Locations

UrbanSuburbanRural and/or frontier

Implementation History

STARS for Families, first implemented in 1993, has been used in eight schools and evaluated in nine studies. Nearly 1,300 students have received the intervention.

NIH Funding/CER Studies

Partially/fully funded by National Institutes of Health: YesEvaluated in comparative effectiveness research studies: Yes

Adaptations

No population- or culture-specific adaptations of the intervention were identified by the developer.

Adverse Effects

No adverse effects, concerns, or unintended consequences were identified by the developer.

IOM Prevention Categories

Universal

Quality of Research

Review Date: March 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.

Outcomes

The Youth Alcohol and Drug Survey was used to collect data on alcohol consumption. Heavy alcohol use was defined as consuming five or more drinks in a row during the past 2 weeks and past 30 days.

Key Findings

In one study, at the 3-month posttest, fewer intervention participants reported drinking heavily during the past 30 days than participants in the comparison group, who received alcohol education booklets to read independently (p < .05). In another study, at the 6-month posttest, fewer intervention participants reported drinking heavily during the past 30 days than participants in the no-treatment control group (p < .05). In a third study, from baseline to the 3-month posttest, heavy drinking decreased in the intervention group and increased in the no-treatment control group (p < .05).

A battery of standardized items was adopted from previous research on youth alcohol use prevention to assess the quantity of alcohol consumed during the past 30 days.

Key Findings

At the 10-week follow-up, intervention participants reported having consumed less alcohol than participants in the comparison group, who received alcohol education booklets to read independently (p < .05).

The Youth Alcohol and Drug Survey was used to collect data on the frequency of alcohol use during the past 7 days and past 30 days.

Key Findings

Three studies compared the intervention to a comparison condition in which participants received alcohol education booklets to read independently. In one study, at the 3-month posttest, fewer intervention participants reported drinking alcohol in the past 7 days (p < .05) and the past 30 days (p < .05) than participants in the comparison group. In another study, of participants who had already started using alcohol, those in the intervention group reported less frequent alcohol use at the 1-month posttest than those in the comparison group (p < .05). In a third study, at the 10-week follow-up, intervention participants reported significantly less frequent alcohol use over the past 30 days than comparison group participants (p < .05).

In another study, fewer participants in the intervention group than in the no-treatment control group reported at the 6-month posttest that they had consumed alcohol in the past 30 days (p < .05).

The Youth Alcohol and Drug Survey was used to collect data on alcohol-related cognitive, social, and behavioral risk and protective factors. These data were used to assign participants to one of the five stages of alcohol use initiation: precontemplation, contemplation, preparation, action, and maintenance.

Key Findings

At the 3-month posttest, fewer intervention participants were in the advanced stages of alcohol use initiation (i.e., preparation, action, maintenance) than participants in the comparison group, who received alcohol education booklets to read independently (p < .05).

The Youth Alcohol and Drug Survey was used to collect data on intentions to use alcohol in the future. Items measure intentions to drink in the next 6 months and intentions to think about using, plan to use, try to use, and use alcohol in the next year.

Key Findings

In one study, at the 3-month posttest, intervention participants reported having significantly fewer intentions to drink alcohol in the future than students in the comparison group, who received alcohol education booklets to read independently (p < .01). This finding remained significant at the 1-year follow-up (p < .01). In another study, at the 6-month posttest, fewer participants in the intervention group than in the no-treatment control group reported intentions to use alcohol in the next 6 months (p < .05).

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:

Reliability of measures

Validity of measures

Intervention fidelity

Missing data and attrition

Potential confounding variables

Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome

Reliability
of Measures

Validity
of Measures

Fidelity

Missing
Data/Attrition

Confounding
Variables

Data
Analysis

Overall
Rating

1: Heavy alcohol use

3.5

2.5

2.5

2.5

2.5

4.0

2.9

2: Quantity of alcohol use

3.5

3.0

2.5

2.5

3.5

4.0

3.2

3: Frequency of alcohol use

3.5

3.0

3.0

2.5

3.5

4.0

3.3

4: Stage of alcohol use initiation

3.5

3.0

2.5

2.5

3.5

4.0

3.2

5: Intentions to use alcohol in the future

3.5

2.5

3.0

2.5

2.5

3.5

2.9

Study Strengths

The studies used randomized designs. The measures were reliable, and self-report measures of alcohol use were validated with saliva dipstick tests. The analyses were appropriate.

Study Weaknesses

Some of the studies did not sufficiently address intervention fidelity. One of the instruments used did not have known psychometric properties. Some of the studies did not clearly explain whether the parents' involvement in the intervention was as intended. Contamination across treatment conditions was possible in some studies. In some cases, attrition was high and there were differences in baseline alcohol use between students who completed the program and those who did not.

Readiness for Dissemination

Review Date: March 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.

Dissemination Strengths

Implementation guidelines supplement the well-designed core program materials. Parent materials are brief and easily accessible. An on-site training relying heavily on role-play techniques is available to program implementers, and additional support from the training facilitator is available after the training by phone or e-mail. Process and outcome measures are provided to support quality assurance.

Dissemination Weaknesses

No information is provided to support program administrators in assessing site readiness, recruiting an implementation team, or identifying program participants. Training includes limited discussion of strategies for relating to adolescents or handling difficult situations. No systematic coaching is available for implementers. It is unclear how some quality assurance tools fit into the overall quality assurance process.

Costs

The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.

Item Description

Cost

Required by Developer

Curriculum

$299 ($250 for training participants)

Yes

Additional parent postcards

$49.95 for 50

No

Additional family take-home lessons

$129.95 for 50

No

1- to 2-hour audio training

$499 per participant

Yes

Implementation consultation

$599 per hour

No

Scannable outcome survey

$5 each

No

Evaluation services (includes scanning/analyzing data and providing a brief written report of the overall findings)

$10 per adolescent

No

Replications

Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.